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Fam Pract Manag. 2001 Jun;8(6):23.

Physicians urged to practice evidence-based medicine

“An unacceptably large proportion of medicine is not practiced in accordance with existing evidence,” said David Eddy, MD, PhD, speaking last month in Tucson at a conference on the subject of evidence-based medicine, sponsored by Group Health Cooperative. Eddy, a senior advisor for Health and Policy Management at Kaiser Permanente in Southern California and an internationally recognized authority on the subject, called on physicians to consider whether their care is indeed based on evidence or merely “expert” opinion, community standards or their own clinical judgment.

Practicing evidence-based medicine, according to Eddy, is simply this:

  • When there is evidence of benefit and value, do it (for example aspirin, beta-blockers and streptokinase for patients with acute myocardial infarction).

  • When there is evidence of no benefit, harm or poor value, don’t do it (for example, routine antibiotics for sore throats).

  • When there is insufficient evidence to know for sure, be conservative and work with patients to weigh the costs and benefits (for example, new treatments).

To make evidence-based medicine the norm in health care, two things need to occur, said Eddy. First, the health care community needs to support and publish high-quality research on topics that are important to patients’ health. But research alone is not enough. “Even when there is evidence, we can’t count on ourselves to automatically do what the evidence shows,” said Eddy. Therefore, the health care community also needs to develop tools, such as evidence-based clinical guidelines, to support physicians in making good decisions.

PRACTICE PEARLS from here and there

An analogy is like a car

Use analogies to help explain complex concepts to your patients, says Terry S. Ruhl, MD, of the Altoona (Pa.) Family Physicians Residency Program. For example, “the spine is like a pile of bricks” and “taking terbutaline is like having 10 cups of coffee at once.” (For more examples, go to www.altoonafp.org/analogies.htm.) But beware: An analogy is like a car. It gets you where you need to go, but if you take it too far, it can break down. To ensure that your patients accurately understand the analogies you use, ask them to explain the analogies back to you.

– Donohue M. Using medical analogies to convey complex ideas. Fam Pract News. Feb. 15, 2001:44.

PRACTICE PEARLS from here and there

Reduce your denial rate

To prevent billing and coding mistakes and reduce denied claims in your practice, try cross-training your staff. Train your billers to code and your coders to bill. For one Ohio multispecialty group, cross-training the billing and coding staff cut their Medicare Part-B claims denial rate by 75 percent.

– Cross-training staff helps slash denial rate by 75 percent. Part B News. April 2, 2001:5–6.

Can I get a witness?

Ninety-five percent of physicians say they have witnessed “serious” medical errors, according to a March/April 2001 Robert Wood Johnson Foundation survey about quality of care. The survey, which polled 600 physicians, 400 nurses and 200 hospital executives, found that 64 percent of physicians had witnessed errors infrequently, 27 percent occasionally and 4 percent frequently. The survey also found that 72 percent of all respondents believe that, although the U.S. health care system has some positive attributes, it is in need of fundamental changes.

Out-of-pocket spending

During the last decade, insured American workers didn’t have to dig as deeply into their pockets to pay for medical expenses not covered by their insurance. According to a study in the March/April 2001 issue of Health Affairs, out-of-pocket spending for medical services, drugs and supplies declined 23 percent from 1990 to 1997. However, this decline was offset by a 29 percent increase in employees’ share of health care premiums.

Nutritional supplements

It’s estimated that about half of all Americans regularly use nutritional supplements not prescribed by their doctors. To help keep you up to date about the nutritional supplement market, the publishers of the Physicians’ Desk Reference recently released the PDR for Nutritional Supplements, which provides scientific analyses of the health benefits – or lack of – for hundreds of over-the-counter products ranging from vitamins to shark cartilage.

Hello, MAMA

Image is everything, and Health and Human Services Secretary Tommy Thompson is considering a name change for the Health Care Financing Administration (HCFA) as part of a plan to boost the agency’s tattered image, according to the April 30 Congress Daily. Who could frown at MAMA, the acronym for HCFA’s proposed new name, the Medicare and Medicaid Association? If Thompson can improve HCFA’s communication, secure additional funding from Congress and update the agency’s computer system (installed in 1970), MAMA might have a healthy glow.


 

Copyright © 2001 by the American Academy of Family Physicians.
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